ONLINE APPLICATION

Name*
First Last
Primary Phone*
Secondary Phone (if applicable)
Email*
Office and/or Dispatcher you talked to
Truck Details
Truck Year*
Truck Make*
Trailer Details
Trailer Year
Trailer Make
OR - the Type of Trailer you want to pull
Personal Details
- The purpose of this application is to determine whether or not the applicant is qualified to operate Motor Carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and Horizon Logistics, LLC.
- Please answer all questions. If the answer to any question is "no" or "none", please write that in. Do not leave it blank.
- Horizon Logistics, LLC. does not discriminate because of age, sex, or race.
Date of Birth
MM slash DD slash YYYY
Current Address*
Street Address Address Line 2 City State ZIP Code
Have you lived at the above address for the past 3 years?*
Where else have you resided?
Previous Address 1*
Street Address Address Line 2 City State ZIP Code
Previous Address 2 (if applicable)
Street Address Address Line 2 City State ZIP Code
In Case of Emergency Contact
Name*
Phone*
Personal References
Name*
Phone*
Name*
Phone*
Name*
Phone*
Employment History
Give a complete record of all employment for the past ten years, if applicable, explaining any gaps such as any unemployment or self-employment. Each driver applicant has the right to review and correct previous employer information.
- Employer #1
- Employer 1 Name*
- Employer Address*
  Street Address Address Line 2 City State ZIP Code
- Contact Person*
  First Last
- Contact Phone*
- Were you subject to the FMCSR's while employed there?*
- Was your job designated as a safety-sensitive function subject to alcohol and controlled substance testing?*
- Begin Date*
  MM slash DD slash YYYY
- End Date*
  MM slash DD slash YYYY
- Position Held*
- Salary/Wage*
- Reason for Leaving*
- More Employers?
- Employer #2
- Employer 2 Name
- Employer Address*
  Street Address Address Line 2 City State ZIP Code
- Contact Person*
  First Last
- Contact Phone*
- Were you subject to the FMCSR's while employed there?*
- Was your job designated as a safety-sensitive function subject to alcohol and controlled substance testing?*
- Begin Date*
  MM slash DD slash YYYY
- End Date*
  MM slash DD slash YYYY
- Position Held*
- Salary/Wage*
- Reason for Leaving*
- Employer #3
- Employer 3 Name
- Employer Address*
  Street Address Address Line 2 City State ZIP Code
- Contact Person*
  First Last
- Contact Phone*
- Were you subject to the FMCSR's while employed there?*
- Was your job designated as a safety-sensitive function subject to alcohol and controlled substance testing?*
- Begin Date*
  MM slash DD slash YYYY
- End Date*
  MM slash DD slash YYYY
- Position Held*
- Salary/Wage*
- Reason for Leaving*
- Employer #4
- Employer 4 Name
- Employer Address*
  Street Address Address Line 2 City State ZIP Code
- Contact Person*
  First Last
- Contact Phone*
- Were you subject to the FMCSR's while employed there?*
- Was your job designated as a safety-sensitive function subject to alcohol and controlled substance testing?*
- Begin Date*
  MM slash DD slash YYYY
- End Date*
  MM slash DD slash YYYY
- Position Held*
- Salary/Wage*
- Reason for Leaving*
- Employer #5
- Employer 5 Name
- Employer Address*
  Street Address Address Line 2 City State ZIP Code
- Contact Person*
  First Last
- Contact Phone*
- Were you subject to the FMCSR's while employed there?*
- Was your job designated as a safety-sensitive function subject to alcohol and controlled substance testing?*
- Begin Date*
  MM slash DD slash YYYY
- End Date*
  MM slash DD slash YYYY
- Position Held*
- Salary/Wage*
- Reason for Leaving*
- Employer #6
- Employer 6 Name
- Employer Address*
  Street Address Address Line 2 City State ZIP Code
- Contact Person*
  First Last
- Contact Phone*
- Were you subject to the FMCSR's while employed there?*
- Was your job designated as a safety-sensitive function subject to alcohol and controlled substance testing?*
- Begin Date*
  MM slash DD slash YYYY
- End Date*
  MM slash DD slash YYYY
- Position Held*
- Salary/Wage*
- Reason for Leaving*
- Driver Experience
- Class of Equipment (Select All that Apply)*
  - Straight Truck
  - Tractor and Semi-Trailer
  - Tractor-Two Trailers
  - Other
- Straight Truck From
  MM slash DD slash YYYY
- To
  MM slash DD slash YYYY
- Approx. # of Miles (Total)
- Tractor & Semi-Trailer From
  MM slash DD slash YYYY
- To
  MM slash DD slash YYYY
- Approx. # of Miles (Total)
- Tractor-Two Trailers From
  MM slash DD slash YYYY
- To
  MM slash DD slash YYYY
- Approx. # of Miles (Total)
- List states operated in for the last 5 years:*
- Have you participated in a driving school?*
  - Yes
  - No
- Name of driving school?
- Have you ever been denied a license, permit or driving privilege to operate a motor vehicle?*
  - Yes
  - No
- Please provide details:*
- Have any license, permit or privilege been suspended or revoked?*
  - Yes
  - No
- Please provide details:*
- Accident Record (past 3 years)
- Date
  MM slash DD slash YYYY
- Nature of Accident (ie. Head on, Etc.)
- Number of Fatalities/Injuries
- Date
  MM slash DD slash YYYY
- Nature of Accident (ie. Head on, Etc.)
- Number of Fatalities/Injuries
- Traffic Conviction and Forfeitures (past 3 years)
- Location
- Date
  MM slash DD slash YYYY
- Charge and Penalties
- Location
- Date
  MM slash DD slash YYYY
- Charge and Penalties
- Driver's License (list each license held in past 3 years)
- State
- License #
- Endorsements/Expiration
- State
- License #
- Endorsements/Expiration

ONLINE APPLICATION

Truck Details

Trailer Details

Personal Details

Employment History

Employer #1

Employer #2

Employer #3

Employer #4

Employer #5

Employer #6

Driver Experience

Accident Record (past 3 years)

Traffic Conviction and Forfeitures (past 3 years)

Driver's License (list each license held in past 3 years)